Missouri Long-Term Care Information Update

Resident to Staff Aggression: Prevention & Response Training

March 30-July 20, 2023: Resident to Staff Aggression: Prevention & Response Training (Webinar)
April 20, 2023: Resident to Staff Aggression: Prevention & Response Training (In Person)

Resident to staff aggression occurs, but it shouldn’t be thought of as just part of a caregivers’ job. Tools for prevention and response to resident aggression are critical for promoting worker safety and satisfaction as well as the resident experience. This interactive, application-based training will explore some of the reasons for resident aggression, provide strategies for violence prevention, de-escalation and during incident response as well as post incident response strategies that promote the prevention of future incidents. The role of policy, consistent and effective communication and a workplace violence prevention culture will be explored. Interactive learning experiences and discussions will help trainees practice and apply learning.

MALA Spring Conference

April 16-18, 2023: Don’t Take a Chance – Bet On MALA
Location: Branson Hilton Landing Hotel and Convention Center

Information including the conference agenda and registration for attending the Missouri Assisted Living Association’s 2023 Spring Conference is now available.

MALA’s ALF Community Based Assessment Training

June 5-7, 2023: 2023 ALF Community Based Assessment Training
Location: Courtyard by Marriott, Columbia

As required by 198.005 RSMo and 19 CSR 30-86.047, residents of Assisted Living Facilities are required to undergo a community based assessment performed by an appropriately trained and qualified individual. This individual must complete a DHSS approved 24-hour training program prior to performing resident assessments. The MALA ALF Assessment Training satisfies this regulatory requirement.

The Green House Project 2023 Conference

July 23-26, 2023: Ready to Impact
Location: Pittsburg, PA

It’s official: Green House and Pioneer are coming together for one incredible event.

Everything you’ve come to expect from our conferences — fellowship, education, new ideas, and fun — now with even more leaders, caregivers, visionaries, and supporters from around the country and the world!

The theme of the first annual Center for Innovation Conference, Ready to Impact, reflects the power our organizations have under one banner. Together, let’s make 2023 a year of real change for elders in the United States and around the world, uniting in one voice to broaden the reach and deepen the impact of our work to build something better.

Funding Opportunity for Missouri Nursing Facility Strike Team and Infrastructure Award

The Missouri Department of Health and Senior Services (DHSS) is excited to announce the Missouri Nursing Facility Strike Team and Infrastructure Award, a reimbursement opportunity available to Skilled Nursing Facilities (SNF) and Long Term Care and Other Nursing Facilities (LTC). Beginning March 1, 2023, facility owners and operators may apply for reimbursement for expenses incurred between July 1, 2022 and August 31, 2023, directly related to preparing, preventing, and responding to the COVID-19 pandemic.

If you operated a Skilled Nursing Facilities or Long Term Care and Other Nursing Facilities licensed with DHSS between July 1, 2022 and August 31, 2023, you are eligible for reimbursement for allowable expenses.

Owner/operator applicant must be registered as a vendor with the State of Missouri prior to submitting an application. If not already registered, visit https://missouribuys.mo.gov/registration. Vendor name and address used in registering as a vendor must be the same vendor name address used on the reimbursement application. Be sure to register only the operating entity and not all individual facilities owned by the same company.

Please see the attached Frequently Asked Questions and Application Checklist documents below.

Missouri Nursing Facility Strike Team and Infrastructure Award FAQ Checklist
Missouri Nursing Facility Strike Team and Infrastructure Award Application
Missouri Nursing Facility Strike Team and Infrastructure Award Eligible Facilities

All questions should be directed to the DHSS Strike Team via email at LTCStrikeTeam@health.mo.gov.

Public Health Emergency (PHE) 1135 Waivers: Updated Guidance for Providers

On February 9, the Department of Health and Human Services (HHS) announced the Public Health Emergency (PHE) for COVID-19 will end on May, 11, 2023. COVID-19 remains a significant priority for the Biden-Harris Administration and over the next several months, the Centers for Medicare & Medicaid Services (CMS) will work to ensure a smooth transition. During the PHE, CMS has used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure easier access to care during the PHE for health care providers and their beneficiaries.

Some of the flexibilities that were created during the pandemic were recently expanded by the Consolidated Appropriations Act, 2023. Others, while critical during our initial responses to COVID-19, are no longer needed. CMS has made further updates to our CMS Emergencies Page with useful information for providers – specifically around major telehealth and individual waivers – that were initiated during the Public Health Emergency (PHE).

Please reference the following guidance in response to the PHE ending May 11, 2023:

Provider-specific fact sheets about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers

CMS COVID-19 Waivers and Flexibilities for Providers include:

  • Physicians and Other Clinicians
  • Hospitals and CAHs (including Swing Beds, DPUs), ASCs and CMHCs
  • Teaching Hospitals, Teaching Physicians and Medical Residents
  • Long Term Care Facilities (Skilled Nursing Facilities and/or Nursing Facilities)
  • Home Health Agencies
  • Hospice
  • Inpatient Rehabilitation Facilities
  • Long Term Care Hospitals & Extended Neoplastic Disease Care Hospitals
  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
  • Laboratories
  • Medicare Shared Savings Program
  • Durable Medical Equipment, Prosthetics, Orthotics and Supplies
  • Medicare Advantage and Part D Plans
  • Ambulances
  • End Stage Renal Disease (ESRD) Facilities
  • Participants in the Medicare Diabetes Prevention Program
  • Intermediate Care Facility for Individuals with Intellectual Disabilities

 Department of Health & Human Services Fact Sheet: https://www.hhs.gov/about/news/2023/02/09/fact-sheet-covid-19-public-health-emergency-transition-roadmap.html

In the coming weeks, CMS will be hosting stakeholder calls and office hours to provide additional information. Please continue to visit the CMS Emergencies Page for continuous updates regarding PHE sunsetting guidance as information becomes available to the public.

Pre-Admission Screening and Resident Review (PASRR) Flexibility Ending May 11, 2023

With the recent announcement from the White House regarding the official end of the Public Health Emergency on May 11, 2023, the waiver that allowed nursing homes to admit new residents who have not received PASRR Level I screenings and Level II evaluations will terminate on May 11, 2023.

That date is beyond the 60 notice that CMS has previously said would be given to allow states to unwind any COVID related changes to their PASRR program. As such, CMS will expect states to resume the completion of PASRR activities prior to admission as of May 12, 2023.

The PASRR process requires that all applicants admitting to Medicaid-certified nursing facilities be screened for possible serious mental disorders or intellectual disabilities and related conditions. This initial pre-screening is referred to as PASRR Level I, and is completed prior to admission to a nursing facility. A negative Level I screen permits admission to proceed and ends the PASRR process unless a possible serious mental disorder or intellectual disability arises later. A positive Level 1 screen necessitates an in-depth evaluation of the individual by the state-designated authority, known as PASRR Level II, which must be conducted prior to admission to a nursing facility.

Long-term care facilities, hospitals, and other referral agencies should educate admission and discharge planners to this requirement- as it is a return to pre-COVID activities that they may be unfamiliar with.

iQIES for Minimum Data Set (MDS) Submission Release on April 17, 2023

CMS is excited to announce that the transition of the Minimum Data Set (MDS) assessment submission and reporting functionality to the Internet Quality Improvement and Evaluation System (iQIES) will occur on Monday, April 17, 2023.

To properly prepare for the transition, the QIES Assessment Submission and Processing (ASAP) system for MDS submissions will be turned off on Thursday, April 13 at 8:00 p.m. ET. Providers should submit completed MDS records prior to 8:00 p.m. ET on April 13 to QIES (ASAP) or wait until 8:00 a.m. ET on April 17 to submit data in iQIES. Providers are expected to take into account all requirements when determining the date they submit completed MDS records, including but not limited to, submission timeliness, claims processing, and care planning requirements.

CMS will provide additional information through various email notifications regarding training, technical guidance, details on what to expect, and more.

Register for an iQIES Account

Please note that failure to obtain access to iQIES prior to April 17, 2023 will impact your ability to submit MDS records. As mentioned in previous communications, nursing home and swing bed providers who are required to submit data to CMS must have at least one staff person assigned and approved as the facility Provider Security Official (PSO), who works for the provider and is responsible for approving all other users for their facility. For information and instructions to register for an iQIES account, please visit: https://qtso.cms.gov/news-and-updates/action-required-register-iqies-account.

iQIES Service Center

If you have questions or require assistance, please contact the iQIES Service Center at iqies@cms.hhs.gov or by phone at (800) 339-9313. Please note that call volume may be higher than normal during this time.

AADD Conference

May 15-16, 2023: 32nd Annual Aging with Developmental Disabilities Conference
Location: St. Charles Convention Center

The Annual Aging with Developmental Disabilities Conference has a goal of bringing the aging and developmental disability professionals together to learn about best support models and practices and the most current information on aging with a developmental disability. Through information, education, and networking, participants from across the United States will have a better understanding of both medical care, medical changes and best practices that will help them support people with developmental disabilities with living their best life as well as end-of-life care.

CMS Releases Updated Resources to Prepare for the May 11 End of the COVID-19 Public Health Emergency and National Emergency

January 30: The Biden Administration announced its intent to end the COVID-19 national emergency and public health emergency declarations on May 11, 2023. To ensure a smooth transition and help protect the health and well-being of the American people, CMS has taken immediate action to update fact sheets and other supporting resources to prepare for changes that will occur beginning on May 11.

Action Pact’s Conversations with Carmen

This year Carmen Bowman will be hosting and presenting the Back to the Future: Moving Dining Forward series with Linda Bump MPH, RD (Registered Dietitian, Licensed Nursing Home Administrator and Action Pact consultant).

February 17, 2023: Are your residents still enduring restricted diets?
March 17, 2023: Are your residents still offered the outdated altered consistency diets?
April 21, 2023: Are your residents still offered artificial food/supplements?
May 19, 2023: Are your residents still only offered the main meal or the alternate/token choice?
June 16, 2023: Are your residents still offered set meal times?
July 21, 2023: Are your residents still offered institutional meals?
August 18, 2023: Are your residents still not involved in preparing food?
September 15, 2023: Is your dining experience still institutional?
October 20, 2023: Are you still not offering the opportunity for people to help themselves?
November 17, 2023: Are you still not celebrating various ethnicities & incorporating themes into the life of your home starting with food and the dining experience?

Temporary Service Disruption – Adult Abuse and Neglect Hotline Online Reporting

The Department of Health and Senior Services regrettably informs you that the Adult Abuse and Neglect Hotline Online Reporting System will experience a temporary service disruption starting at 10p.m. February 8 until 6a.m. February 9 to allow for scheduled maintenance and updates. During this time, please make all Adult Abuse and Neglect Hotline Reports using our toll-free number, 800-392-0210, which is operational from 7a.m. to 8p.m., 7 days a week, 365 days a year.

We apologize for any inconvenience this may cause and thank you for your patience and continued partnership as we work to keep Missouri seniors and adults with disabilities safe.

To report Adult Abuse, Neglect, or Financial Exploitation online, go to www.Health.Mo.Gov/abuse.

 

Registration Open – Promoting COVID-19 Bivalent Vaccinations for Older Adults: Long-Term Care Provider Perspectives

February 9, 2023: Promoting COVID-19 Bivalent Vaccinations for Older Adults Webinar (3:00-4:00 p.m. ET)

Register for the upcoming Communities of Practice webinar focused on promoting COVID-19 bivalent vaccinations for older adults and residents/staff in long-term care settings; speakers will present successful strategies in increasing bivalent booster uptake in their communities.

Moderated by CDC’s State, Tribal, Local, and Territorial (STLT) Task Force.

Featuring presentations from:

  1. Patrick Cote, PharmD, Director, Pharmacy Services, Good Samaritan Society (Sanford Health), North Dakota
  2. Kaylea Watkins, RN, CIC, Infection Preventionist, Providence Mount St. Vincent, Seattle, WA
  3. Winter Viverette, MAIO, MATD, Infection Prevention Specialist, Healthcare Settings, Chicago Department of Public Health
  4. Karen McDonald, BSN, RN, Vice President, Chief Clinical Officer, Mission Health Communities

Register Now: https://phf-org.zoom.us/webinar/register/WN_5y6WJDbzQduEy5z1exaBxQ

Payroll-Based Journal (PBJ) Submission Deadline Reminder

Nursing homes are required to electronically submit direct care staffing information to the Payroll-Based Journal (PBJ) system. Submissions must be received by the end of the 45th calendar day (11:59 PM Eastern Standard Time) after the last day in each fiscal quarter to be considered timely. PBJ data for 10/1/22 through 12/31/22 is due February 14, 2023.

Please submit PBJ data as soon as possible to avoid delays. CMS recommends running staffing reports in CASPER prior to the submission deadline to ensure the accuracy and completeness of submissions. Please remember, the Final File Validation Report verifies that the submission was successful.

Please note: If you need assistance with the PBJ quarterly submission and the deadline falls on a weekend, you must contact the QIES/iQIES Service Center no later than the Friday before the submission deadline, as the Service Center will be unavailable to assist on the weekend.

More information about PBJ can be found on the following webpages:

CMS PBJ webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Staffing-Data-Submission-PBJ
PBJ Reference Manuals – https://qtso.cms.gov/vendors/payroll-based-journal-pbj-vendors/reference-manuals
PBJ Training – https://qtso.cms.gov/training-materials/payroll-based-journal-pbj

SNF Quality Reporting Program (QRP) Submission Deadline Reminder

SNFs are required to report data to meet the SNF QRP requirements. The submission deadline for the SNF QRP is approaching. MDS and NHSN data for 7/1/22 through 9/30/22 must be submitted no later than 11:59 p.m. on February 15, 2023.

The Minimum Data Set (MDS) 3.0 must be transmitted to the Centers for Medicare & Medicaid Services (CMS) through the Assessment Submission and Processing (ASAP) system to the Quality Improvement Evaluation System (QIES). Data for the National Healthcare Safety Network (NHSN) measures must be submitted to the Centers for Disease Control and Prevention (CDC). No additional data submission is required for the claims-based measures.

As a reminder, it is recommended that providers run applicable CASPER reports prior to each quarterly reporting deadline, in order to ensure that all required data has been submitted.

Swingtech sends informational messages to SNFs that are not meeting APU thresholds on a quarterly basis ahead of each submission deadlines. If you need to add or change the email addresses to which these messages are sent, please email QRPHelp@swingtech.com and be sure to include your facility name and CMS Certification Number (CCN) along with any requested email updates.

More information about SNF QRP can be found on the following webpages:

CMS SNF QRP Data Submission Deadlines webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Data-Submission-Deadlines
CMS SNF QRP Help webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-QRP-Help
CMS SNF QRP Measures and Technical Information webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Measures-and-Technical-Information
CMS SNF QRP Training Webpage – https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Skilled-Nursing-Facility-Quality-Reporting-Program/SNF-Quality-Reporting-Program-Training

DMH Free Webinar – Tools for Everyone

February 9, 2023: 1:00 Registration
February 14, 2023: 1:00 Registration
February 22, 2023: 10:00 Registration
February 28, 2023: 1:00 Registration

Presenter: Kathleen Deppeler, Director of Positive Supports

Tools of Choice is an evidence-based program focused on the implementation of universal positive practices. This two-hour introductory training is open to community members, parents, and professionals. It covers key concepts of the Tools of Choice curriculum, including:

  • What is Behavior?
  • Building Positive Relationships
  • How to Increase Desirable Behavior

Join the Positive Support Consultants in learning strategies to make positive change by implementing universal positive practices.

MC5 Event

February 17, 2023: Culture Change and Hospice End of Life Care
Location: Farmington Public Library

In this presentation, it will be discussed promoting a culture change of person-centered care with the perception of hospice and end-of-life care and provide knowledge on how receiving the full hospice benefit promotes better quality of life and dignity.

February 22, 2023: Unload Medication Overload: Making Sense of Polypharmacy and Deprescribing (Virtual Meeting)
Presenter: Hedva Barenholtz Levy, PharmD, BCPS, BCGP, Director, HbL, PharmaConsulting

Medication overload or polypharmacy is a main culprit of medication-related problems, reduced quality of life and high healthcare costs among older individuals.

Consequences of polypharmacy are multifold and can be prevented with a more judicious approach to medication use. Efforts to address widespread medication overload are gaining momentum, including deprescribing of drug therapy. Professionals who work with older adults need to be familiar with the latest trends and strategies to optimize or “right-size” medications and serve as patient and family advocates.

Missouri Developmental Disabilities Council Training

March 6-7, 2023: Springfield, 8:30 – 4:30 Registration Link

March 7, 2023: 12:30 – 4:30 Registration Link

March 8-9, 2023: Independence, 8:30 – 4:30 Registration Link

March 9, 2023: 12:30 – 4:30 Registration Link

March 27-28, 2023: Columbia, 9:00 – 5:00 Registration Link

March 28, 2023: 1:00 – 5:00 Registration Link

March 29-30, 2023: St. Louis, 9:00 – 5:00 Registration Link

March 30, 2023: 1:00 – 5:00 Registration Link

Niagara University Disability Awareness Training has received funding from the Missouri Developmental Disabilities Council to provide education for anyone involved in emergency planning, preparedness, response, and recovery as it relates to individuals with disabilities and access and functional needs.

This program identifies the responsibilities of both emergency management personnel and disability advocates during an emergency. It also introduces the four modules necessary for proper response that include Disability Awareness Training, the Americans with Disabilities Act specific to Emergency management, emergency plan content, and Inclusive Planning and Active Participation.

LeadingAge Webinar Series – Essentials of the LTC Director of Nursing Role Part 2

March 29, 2023: Essentials of the LTC Director of Nursing Part 2
March 30, 2023: Essentials of the LTC Director of Nursing Part 2

LeadingAge Missouri in coordination with LeadingAge Iowa is pleased to announce a virtual series that will take place in three segments over the first half of 2023 that will aid in developing the Director of Nursing (DON) role in nursing homes. Elements of this series will focus on budgeting and quality assurance; survey processes and regulations; and human resources, customer service, and leadership.

Each segment of this series is designed to provide in-depth information and discussion on each topic without taking the series in a sequential order or taking all 3 sections of the series. By making each of the 3 segments standalone, you can better address succession planning by having individuals attend as their nurse leadership skills are identified. An additional section in this series will be added to the events calendar in June.

Dementia Across the Continuum: Exploring Best Practices in Every Setting

April 28, 2023: Dementia Across the Continuum: Exploring Best Practices in Every Setting
Location: Saint Louis University Campus

The workshop will discuss the benefits of a multidisciplinary approach to maximize functional abilities at each dementia stage and include expert presenters from hospital, home, rehab, and long-term care settings. Learners will gain skills for effective communication strategies as well as a structured and organized approach to identify appropriate interventions across dementia care settings.

Speakers include Dr. Lenise Cummings-Vaughn, a Washington University of St. Louis Physician in the Division of Geriatrics and Associate Medical Director at Parc Provence; Dr. Beth Templin, a Board Certified Geriatric Physical Therapist and founder of HouseFit, an innovative outpatient physical therapy company; Dr. Sarah Pease, Occupational Therapist at Memory Care Home Solutions; Amy Sobrino, Social Worker at Memory Care Home Solutions; and insight and advice from people living with dementia and their care partners on best practices.

Course approval applications are being submitted for six hours of continuing education credit for nursing home administrators, physical therapists, physicians, psychologists, occupational therapists, speech therapists, and social workers.

News Release: Missouri Alzheimer’s State Task Force releases report and recommendations

More than 120,000 individuals in Missouri are currently living with Alzheimer’s or related dementia. With the aging of the baby boomer population, that number will escalate to more than 130,000 by 2025. A recent report, Missouri Alzheimer’s State Task Force Report and Recommendations identifies areas with strategies for the State of Missouri to address and respond to the escalating public health crisis regarding Alzheimer’s.

Commissioned by the 101st General Assembly, the Alzheimer’s State Task Force members were appointed by Governor Parson. Task force members were commissioned to:

  • Assess the current and future impact of Alzheimer’s disease on Missourians.
  • Examine existing services and resources for persons with Alzheimer’s and their caregivers.
  • Develop recommendations to respond to the public health crisis of Alzheimer’s in Missouri.
  • Ensure inclusion of all ethnic and racial populations that have a higher risk.
  • Identify opportunities for the state to partner with federal government entities.
  • Provide information and coordination across all state agencies regarding Alzheimer’s.
  • Examine dementia-specific training requirements across health care, adult protective services workers, law enforcement and all other areas in which staff are involved with the delivery of care to those with Alzheimer’s disease and other dementias.
  • Develop strategies to increase the diagnostic rate of Alzheimer’s disease in Missouri.

“Alzheimer’s disease poses a grave and growing challenge to Missouri and our nation,” said Paula F. Nickelson, acting director of the Missouri Department of Health and Senior Services. “The Task Force did a tremendous job gathering information and developing recommendations that will assist in the treatment and prevention of Alzheimer’s and benefit those with Alzheimer’s, their caregivers and their family members.”

Upon completion of reviewing current services and resources related to Alzheimer’s and other dementias and hearing the needs of Missourians through eight community forums, the Alzheimer’s State Plan Task Force identified four focus areas.

  • Advance Risk Reduction, Early Detection and Timely Diagnosis
  • Increase Access to Care, Support, and Treatment
  • Improve Quality of Care
  • Ensure a Coordinated Statewide Response

“Gathering input from persons living with Alzheimer’s disease, family caregivers and stakeholders from across the state was a critical part of the planning process,” said Nickelson. “The voices of those who spoke during the in-person town hall-style community forms and those who completed surveys are considered throughout the plan.”